Healthcare Provider Details

I. General information

NPI: 1992945307
Provider Name (Legal Business Name): KC BARIATRIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23401 PRAIRIE STAR PARKWAY SUITE B-300
LENEXA KS
66227
US

IV. Provider business mailing address

PO BOX 7913
CAROL STREAM IL
60197-7913
US

V. Phone/Fax

Practice location:
  • Phone: 913-677-6319
  • Fax: 913-677-1540
Mailing address:
  • Phone: 913-677-6319
  • Fax: 913-677-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHERYL A WENZ
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 913-677-6319